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General NPI Number Information
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NPI Number | 1912467689
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Entity Type | Individual
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Provider Name | RANDI LANE LOCKAMY FNP-C
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Gender | Female
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Dates
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Enumeration Date | 03/20/2019
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Last Update Date | 09/19/2021
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Provider Practice Location Address
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Address Line | 618 S MAIN ST
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City | REIDSVILLE
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State | NC
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Zip | 27320-5020
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Country | US
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Telephone | 336-951-4501
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Fax |
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Provider Business Mailing Address
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Address Line | 1201 HYLAN AVE
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City | HAMLET
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State | NC
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Zip | 28345-4751
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Country | US
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Telephone | 843-992-3259
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 5011601
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License Number State | NC
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